Research Article 26 Ved ABSTRACT Objective: This study examined cannabis use and motives (i.e., medical, non-medical [‘recreational’]) for first use and current use among young adult cancer survivors (ages 18-39). Method: We analyzed 2024 baseline survey data from 155 young adult cancer survivors (Mage = 32.89 [SD = 4.89], 87.7% female, 81.9% White, M = 1.34 [SD = 1.04] years post-treatment) regarding cannabis use, use motives (i.e., medical, non- medical), use characteristics (e.g., frequency/mode), and quality of life (PROMIS). Analyses characterized participants by lifetime use, past-month use, and first use for medical or non-medical purposes; multivariable binary logistic regression assessed correlates of past-month cannabis use among all participants and among those reporting lifetime use, respectively. Results: Of those reporting lifetime use (n = 68, 43.9%), 48 (70.6%) first used for non-medical purposes and 18 (26.5%) for medical. Among those reporting past-month use (n = 41, 26.5%), 4 (9.8%) used for only medical purposes, 12 (29.3%) primarily medical but some non-medical, 6 (14.6%) equally medical/non-medical, 6 (14.6%) primarily non-medical but some medical, and 4 (9.8%) only non-medical. Common reasons for first and current medical use included pain, insomnia, anxiety, and nausea. Past-month use among all participants was associated with less advanced cancer stage, treatment involving chemotherapy, and greater anxiety symptoms. Among those reporting lifetime use, past-month use was also associated with first using for non-medical purposes. Conclusions: A large proportion of young adult survivors first used cannabis for non-medical purposes but also reported medical use. It is crucial to understand use motives and trajectories over time to identify those who may benefit from medical use or face use-related harms. Key words: = Cancer survivorship; young adult cancer survivors; cannabis use; cannabis use motives; quality of life; young adults Darcey M. McCready1, Laura C. Schubel1,2, Hannah Arem2,3, Cassidy R. LoParco1, Afrah Howlader4, Sheena Shajan1, Palash Bhanot1, & Carla J. Berg1,5 1Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University 2Healthcare Delivery Research, MedStar Health Research Institute 3Department of Oncology, Georgetown University 4Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University 5GW Cancer Center, George Washington University Cannabis 2025 © Author(s) 2025 researchmj.org 10.26828/cannabis/2025/000321 Volume 8, Issue 3 Cannabis Use for Medical or Non-Medical Purposes in a Sample of Young Adult Cancer Survivors in the United States Corresponding Author: Carla J. Berg, PhD, MBA, Professor, Department of Prevention & Community Health, Milken Institute School of Public Health, George Washington University, Science & Engineering Hall, 800 22nd St NW, #7000C, Washington, DC 20052. Phone: (202) 994-0168. Email: carlaberg@gwu.edu. Cannabis, A Publication of the Research Society on Marijuana 27 Cannabis has become increasingly accessible as more states legalize medical and non-medical (i.e., ‘recreational’) cannabis. This has coincided with increases in cannabis use, particularly among young adults (Substance Abuse and Mental Health Services Administration [SAMHSA], 2024). Notably, young adult cancer survivors may have particularly high cannabis use rates (Lee et al., 2023). This is an important population, given the >80,000 cancer diagnoses among US young adults (ages 18-39) annually (American Cancer Society [ACS], 2023) and their high survival rates (e.g., 5-year survival is >80%) and increasing life expectancy (ACS, 2023). Motives for cannabis use are diverse. Non- medical purposes may include enjoyment, social enhancement, or relaxation, and medical use may be aimed at addressing certain symptoms such as pain or nausea. For many individuals, particularly young adults, first time cannabis use is largely experimental or for non-medical purposes (Lee et al., 2007). However, cannabis use motives are not mutually exclusive. A Canadian study found that, among individuals using cannabis, 80.6% reported using for non-medical reasons, and 38.6% also used for some therapeutic benefit (Turna et al., 2020). One US-based study of young adults reporting past-month cannabis use found that 37.1% used only for non-medical purposes, 23.5% primarily non-medical, 21.5% equally for both medical and non-medical, and 17.8% for only or primarily medical (Sridharan et al., 2024). Furthermore, motives for use may change over time; for example, an individual’s use could transform from non-medical to medical use after noticing the effects of cannabis on certain physical or mental health symptoms or conditions. Conversely, medical use may change to non- medical use if the symptoms being treated with cannabis are resolved (or cannabis did not prove to be an effective treatment option) or other effects are perceived as enjoyable. Furthermore, use motives may coincide with one another and/or become challenging to differentiate (Turna et al., 2020). Among the most widely-acknowledged medical uses of cannabis relate to cancer and its treatment (e.g., chemotherapy-related nausea and/or vomiting, pain; Abrams, 2022). The National Academies of Sciences, Engineering, and Medicine reported that there is conclusive evidence for cannabis or cannabinoid-based treatments to ameliorate chemotherapy-related nausea, as well as evidence for reducing chronic pain (Abrams, 2022). While the medical community has been slowly (but increasingly) accepting the use of cannabis-based therapies for these symptom (Abrams, 2022; ACS, 2024), a significant proportion of young adult cancer survivors report using cannabis and often indicate sleep disturbances, pain, and mood disorders as primary use motives (Halpern et al., 2024). Understanding cannabis use motives can provide insight into use patterns and the potential risks and benefits of cannabis use (Gex et al., 2024; Halpern et al., 2024). While cannabis may have potential for treating certain medical conditions or symptoms (Abrams, 2022), its use among young adults may be associated with negative consequences (e.g., occupational, academic, and financial challenges, etc.) when used improperly (Jordan & Andersen, 2017; Pearson et al., 2017; Rioux et al., 2018; Terry- McElrath et al., 2022). Moreover, one possible risk is problematic use or addiction, especially if use is frequent or involves highly potent products (e.g., cannabis concentrates; Terry-McElrath et al., 2022), both of which are particularly likely in young adults (Cerdá et al., 2020). With increases in cannabis use among young adults (SAMHSA, 2024), in access to medical and non-medical cannabis nationally, and in interest in utilizing cannabis to offset cancer side effects among the medical community (Sexton et al., 2021), understanding correlates and patterns of cannabis use among young adult cancer survivors may allow researchers and medical professionals to identify those who may develop detrimental use trajectories or related outcomes. Thus, this study analyzed data from a sample of young adult cancer survivors and examined: 1) cannabis use characteristics and reasons (i.e., medical, non- medical) for first use and current use; and 2) factors (including reasons for first use) associated with past-month use. METHODS Study Design Current analyses focus on baseline survey data (February-September 2024) among 155 young adult cancer survivors (ages 18-39) who participated in the Achieving Wellness After Cannabis Use Among Young Adult Cancer Survivors 28 Reaching the End of treatment (AWARE) study, a randomized clinical trial (RCT) testing a behavioral intervention focused on quality of life (McCready et al., 2024). This study was approved by the George Washington University Institutional Review Board. Participants and Recruitment In February–September 2024, participants were recruited via ads through a third-party vendor, BuildClinical. Participant inclusion criteria were: 1) 18–39 years old, 2) within 3 years of completing cancer treatment or on maintenance chemotherapy, 3) US resident, and 4) English- speaking. Exclusion criteria were: 1) cancer recurrence since initial treatment completion; 2) diagnosis of central nervous system cancer (to ensure requisite mental/emotional functioning for program engagement); 3) prior diagnosis of alcohol/drug dependency, psychosis, bipolar disorder, or major depressive disorder; and 4) in hospice. Those who clicked on ads (e.g., “Remote Cancer Survivor Research Study”) were sent to a webpage describing study procedures, risks, benefits, and compensation. Interested and potentially eligible participants authorized BuildClinical to provide their contact information (name, state residency, email, phone number) to the study team. The study team then contacted potential participants via email, text, and/or phone to obtain consent, confirm eligibility, and administer the baseline survey (via REDCap). Data Collection Data collection for the parent trial involved ~15-minute web-based surveys administered (via REDCap) at baseline, end-of-treatment (8 weeks post-baseline), and follow-up (16 weeks post- baseline), with $50 Amazon e-gift codes for completing each survey. Current analyses used the following measures collected at baseline: Cannabis use, reasons for first and current use, use characteristics. Participants were asked if they ever used cannabis in their lifetime; if they indicated ‘yes’, they were asked how many days in the past 30 days they used cannabis (1-30). Those reporting lifetime use were also asked, “Do you have a medicinal marijuana card? (yes/no)”; “Did you first use marijuana for medical or recreational purposes?” (yes/no). Those indicating medical purposes were then asked, “For what medical condition did you first use marijuana?” [open- ended]. Participants reporting past-month use were asked, “Would you consider your current use of marijuana to be for medical or recreational purposes? only medical; primarily medical but occasionally recreational; equally for medical and recreational; primarily recreational but occasionally medical; only recreational” (Sridharan et al., 2024). Those indicating any medical use were asked, “For what medical condition(s) do you currently use marijuana?” [open-ended]. Those reporting past-month use were also asked, “How do you use marijuana most of the time? smoked in a joint, bowl, or water pipe; vaporized with a vaporizer; ingested with or without food (e.g., cannabis oil, drink, edible); other (specify)” and “Where do you usually buy/get marijuana? don't buy it; get it from friends for free; medical dispensary; recreational dispensary; purchase from dealer/acquaintance; other (specify)” (Berg et al., 2024). Quality of life. We administered the 43-item Patient Reported Outcome Measurement Information System (PROMIS) Global Health Scale V2 (Hays et al., 2009). We computed mean scores for each of the following 7 subscales: ability to participate in social roles/activities (6 items; α = .95), physical functioning (6 items; α = .90), fatigue (6 items; α = .94), sleep disturbance (6 items; α = .91), pain interference (6 items; α = .96), anxiety (6 items; α = .93), and depression (6 items; α = .93). Pain intensity is a single item. Sociodemographic and cancer-related factors. Participants reported sociodemographic characteristics (e.g., age, sex, sexual orientation, ethnicity, race, education level, employment status, relationship status, parental status), state of residence, and cancer diagnosis/treatment factors (e.g., site and stage at diagnosis, treatments, date of diagnosis and treatment completion). Data Analysis Survey data were analyzed using IBM SPSS Statisics Version 27 with an alpha of .05. Descriptive analyses were used to characterize participants. Bivariate analyses were used to characterize participants’ sociodemographics, Cannabis, A Publication of the Research Society on Marijuana 29 cancer-related factors, and quality of life measures in relation to lifetime cannabis use, past-month use, and first use for medical vs. non- medical use, using t-tests and ANOVAs for continuous variables and Chi-square tests for categorical variables. We conducted 2 multivariable binary logistic regression models assessing factors associated with: 1) past-month use among all participants; and 2) past-month use among participants reporting lifetime use (to assess first use for medical vs. non-medical purposes as an independent variable of past- month use). Each model included the quality of life measures; first use for medical vs. non- medical purposes was also included in the model among participants reporting lifetime use. Covariates included in the models were guided by the existing literature and bivariate analyses. Few associations were found between sociodemographics, cancer-related factors, and past-month use. Thus, to adjust for potential confounding variables, we conservatively chose to include the following variables: 1) age, to address potential cohort effects; 2) sex assigned at birth, given the well-documented differences in prevalence among males and females (SAMHSA, 2024); 3) cancer stage, due to different treatment experiences based on stage; 4) whether chemotherapy was used in treatment, as chemotherapy-related symptoms (e.g., nausea) are common and frequently cited reasons for medical cannabis use (Abrams, 2022); and 5) time since treatment completion, to account for potentially greater intensity of physical symptoms or emotional distress related to time since completion (Berkman et al., 2023; Wong et al., 2017). RESULTS Participant Characteristics Shown in Table 1, the survey sample (n = 155) was an average age of 32.89 (SD = 4.89), 87.7% (n = 136) female, 8.4% (n = 13) Hispanic, 81.9% (n = 127) White, 7.1% (n = 11) Black, 12.2% (n = 19) Asian, 42.6% (n = 41.9) with >bachelor’s degree, 81.3% (n = 126) employed full- or part-time, 63.2% (n = 98) with income ≥$4,200 per month, 63.9% (n = 99) married/cohabitating, and 66.5% (n = 103) had children. Nearly half (48.4%, n = 75) were diagnosed with breast cancer, and 13.7% (n = 21) were diagnosed with stage 1 cancer, 52.3% (n = 80) stage 2, 22.2% (n = 34) stage 3, and 11.8% (n = 19) stage 4. On average, participants were 2.26 (SD = 1.22) years post-diagnosis and 1.34 (SD = 1.04) years post-treatment. Cannabis Use Characteristics Shown in Tables 1 and 2, 43.9% (n = 68) participants reported lifetime cannabis use, and 26.5% (n = 41) reported past-month use. Among participants reporting past-month use (Table 3), average number of days used was 10.00 (SD = 10.54), 26.8% (n = 11/41) had a medical cannabis card, and primary modes of use were ingesting via edibles (75.6%, n = 31/41), vaporizing (22.0%, n = 9/41), and smoking (14.6%, n = 6/41). The largest proportion obtained cannabis from non-medical dispensaries (46.3%, n = 19/41), followed by medical dispensaries (22.0%, n = 9/41), friends (12.2%, n = 5/41), or dealers (4.8%, n = 2/41). Cannabis Use Among Young Adult Cancer Survivors 30 Table 1. Participant Characteristics in Relation to Lifetime Cannabis Use and Purpose of First Use in Young Adult Cancer Survivors Lifetime cannabis use Among participants reporting lifetime use, purpose of first use a All N = 155 (100%) No n = 87 (56.1%) Yes n = 68 (43.9%) Medical n = 18 (26.5%) Non-medical n = 48 (70.6%) Variables M (SD) or n (%) M (SD) or n (%) M (SD) or n (%) p-value M (SD) or n (%) M (SD) or n (%) p-value Legal factors (n, %) * Medical use legal 109 (76.8) 55 (70.5) 54 (84.4) .072 14 (82.4) 38 (84.4) .999 Non-medical use legal 83 (58.5) 40 (51.3) 43 (67.2) .062 13 (76.5) 29 (64.4) .544 Sociodemographic factors Age (M, SD) 32.89 (4.89) 32.77 (4.45) 33.04 (5.43) .730 33.67 (6.08) 32.75 (5.32) .776 Female (n, %) 136 (87.7) 74 (85.1) 62 (91.2) .326 18 (100.0) 42 (87.5) .254 Hispanic/Latino (n, %) 13 (8.4) 9 (10.3) 4 (5.9) .391 2 (11.1) 2 (4.2) .530 Race (n, %) b White 127 (81.9) 70 (80.5) 57 (83.8) .676 16 (88.9) 40 (83.3) .361 Black 11 (7.1) 9 (10.3) 2 (2.9) .114 1 (5.6) 1 (2.1) .735 Asian 19 (12.2) 9 (10.3) 10 (14.7) .465 1 (5.6) 8 (16.7) .189 Other 5 (3.2) 3 (3.4) 2 (2.9) .999 2 (0.0) 2 (4.2) .651 Education >bachelor’s degree (n, %) 65 (41.9) 34 (39.1) 31 (45.6) .424 9 (50.0) 22 (45.8) .202 Employed full/part-time (n, %) c 126 (81.3) 71 (81.6) 55 (80.9) .985 10 (55.6) 43 (89.6) .068 Household income ≥$4,200/mo (n, %) d 98 (63.2) 49 (56.3) 49 (72.1) .103 10 (55.6) 38 (79.2) .074 Married/cohabitating (n, %) 99 (63.9) 55 (63.2) 44 (64.7) .468 10 (55.5) 33 (68.7) .742 Parent (n, %) 103 (66.5) 58 (66.7) 45 (66.2) .999 12 (66.7) 31 (64.6) .583 Medical history Cancer type (n, %) .166 .785 Breast 75 (48.4) 41 (47.1) 34 (50.0) 10 (55.6) 22 (45.8) Lymphoma 34 (21.9) 22 (25.3) 12 (17.6) 2 (11.1) 10 (20.8) Leukemia 17 (11.0) 12 (13.8) 5 (7.4) 1 (5.6) 4 (8.3) Other e 29 (18.7) 12 (13.8) 17 (25.0) 5 (27.8) 12 (25.0) Cancer stage (M, SD) f 2.32 (0.86) 2.36 (0.839) 2.27 (0.89) .534 2.33 (0.84) 2.30 (0.89) .118 Years since diagnosis (M, SD) 2.26 (1.22) 2.26 (1.24) 2.25 (1.20) .957 2.56 (1.20) 2.17 (1.20) .344 Treatments (n, %) Chemotherapy 138 (89.0) 74 (85.1) 64 (94.1) .118 18 (100.0) 44 (91.7) .413 Radiation 69 (44.5) 39 (44.8) 30 (44.1) .999 10 (55.6) 18 (37.5) .114 Surgery 101 (65.2) 54 (62.1) 47 (69.1) .399 13 (72.2) 32 (66.7) .574 Years since treatment completed (M, SD) 1.34 (1.04) 1.40 (1.01) 1.25 (1.08) .367 1.44 (0.98) 1.23 (1.12) .198 Quality of life – PROMIS (M, SD) Social roles/activities 51.09 (8.39) 51.52 (8.44) 50.53 (8.35) .469 47.07 (8.25) 52.04 (8.17) .066 Physical function 48.13 (7.57) 48.35 (7.53) 47.85 (7.66) .687 44.33 (6.47) 49.38 (7.77)) .036 Fatigue 54.35 (8.94) 53.85 (9.41) 54.99 (8.33) .433 57.81 (7.36) 53.85 (8.65) .218 Sleep disturbance 51.17 (9.20) 50.47 (9.61) 52.07 (8.64) .286 54.26 (8.04( 51.20 (8.96) .440 Pain interference 50.64 (8.78) 50.04 (8.73) 51.40 (8.84) .339 55.96 (8.23) 49.47 (8.59) .018 Anxiety 58.00 (8.89) 56.27 (9.32) 60.21 (7.83) .006 62.13 (7.88) 59.39 (7.90) .415 Depression 51.86 (9.08) 50.63 (9.91) 53.44 (7.69) .056 55.64 (8.12) 52.57 (7.50) .348 Note. * 13 participants missing state identifiers. a Prefer not to answer n = 2. b Totals >156 due to “check all that apply”. Other: American Indian/Alaskan Native n = 1; Middle Eastern/North African n = 3; Unspecified n = 1. c Other: Student n = 12; Homemaker n = 9; Out of work >1 year n = 4; Out of work <1 year n = 2; Unable to work/disabled n = 2; Unspecified n = 1. d Prefer not to answer n = 10. e Other: Colorectal n = 6; Cervical n = 5; Sarcoma n = 5; Other n = 13 (n = 1 for Mouth, Lung, Melanoma, Multiple Myeloma, Testicular, Thyroid, etc.). f Cancer stage – 1: n = 21 (13.7), 2: n = 80 (52.3%), 3: n = 34 (22.2%), 4: n = 19 (11.8%). Cannabis, A Publication of the Research Society on Marijuana 31 Table 2. Participant Characteristics in Relation to Past-Month Cannabis Use and Purpose if First Use in Young Adult Cancer Survivors Past-month cannabis use Among participants reporting past- month use, purpose of first use a All N = 155 (100%) No n = 114 (73.5%) Yes n = 41 (26.5%) Medical n = 13 (31.7%) Non-medical n = 26 (63.4%) Variables M (SD) or n (%) M (SD) or n (%) M (SD) or n (%) p-value M (SD) or n (%) M (SD) or n (%) p-value Legal factors (n, %) * Medical use legal 109 (76.8) 76 (72.4) 33 (89.2) .042 10 (83.3) 21 (91.3) .594 Non-medical use legal 83 (58.5) 57 (54.3) 26 (70.3) .120 9 (75.0) 16 (69.6) .999 Sociodemographic factors Age (M, SD) 32.89 (4.89) 32.71 (4.64) 33.39 (5.54) .447 33.54 (5.78) 33.23 (5.74) .949 Female (n, %) 136 (87.7) 99 (86.8) 37 (90.2) .782 13 (100.0) 22 (84.6) .278 Hispanic/Latino (n, %) 13 (8.4) 11 (9.6) 2 (4.9) .516 1 (7.7) 1 (3.8) .825 Race (n, %) b White 127 (81.9) 92 (80.7) 35 (85.4) .506 11 (84.6) 23 (88.5) .332 Black 11 (7.1) 10 (8.8) 1 (2.4) .290 1 (7.7) 0 (0.0) .332 Asian 19 (12.2) 14 (12.3) 5 (12.2) .999 1 (7.7) 3 (11.5) .232 Other 5 (3.2) 4 (3.5) 1 (2.4) .999 0 (0.0) 1 (3.8) .744 Education >bachelor’s degree (n, %) 65 (41.9) 46 (40.4) 19 (46.3) .191 7 (53.8) 12 (46.2) .186 Employed full/part time (n, %) c 126 (81.3) 95 (83.3) 31 (75.6) .568 7 (53.8) 22 (84.6) .442 Household income ≥$4,200/mo (n, %) d 98 (63.2) 71 (62.3) 27 (65.9) .418 7 (53.8) 19 (73.1) .088 Married/cohabitating (n, %) 99 (63.9) 72 (63.1) 27 (65.8) .866 7 (54.9) 19 (73.1) .910 Parent (n, %) 103 (66.5) 77 (67.5) 26 (63.4) .631 10 (76.9) 14 (53.8) .202 Medical history Cancer type (n, %) .506 .897 Breast 75 (48.4) 54 (47.4) 21 (51.2) 7 (52.8) 12 (46.2) Lymphoma 34 (21.9) 27 (23.7) 7 (17.1) 2 (15.4) 5 (19.2) Leukemia 17 (11.0) 14 (12.3) 3 (7.3) 1 (7.7) 2 (7.7) Other e 29 (18.7) 19 (16.7) 10 (24.4) 3 (23.1) 7 (26.9) Cancer stage (M, SD) f 2.32 (0.86) 2.36 (0.82) 2.21 (0.95) .324 2.38 (0.96) 2.21 (0.93) .160 Years since diagnosis (M, SD) 2.26 (1.22) 2.23 (1.21) 2.35 (1.27) .588 2.69 (1.37) 2.21 (1.23) .374 Treatments (n, %) Chemotherapy 138 (89.0) 98 (86.0) 40 (97.6) .042 13 (100.0) 25 (96.2) .744 Radiation 69 (44.5) 49 (43.0) 20 (48.8) .522 7 (53.8) 11 (42.3) .263 Surgery 101 (65.2) 73 (64.0) 28 (68.3) .624 9 (69.2) 17 (65.4) .596 Years since treatment completed (M, SD) 1.34 (1.04) 1.33 (1.02) 1.34 (1.11) .966 1.62 (1.04) 1.31 (1.12) .155 Quality of life – PROMIS (M, SD) g Social roles/activities 51.09 (8.39) 51.36 (8.34) 50.34 (8.58) .507 46.39 (8.94) 52.59 (7.96) .065 Physical function 48.13 (7.57) 48.25 (7.75) 47.80 (7.12) .742 45.09 (7.05) 49.52 (6.96) .114 Fatigue 54.35 (8.94) 53.99 (9.51) 55.33 (7.12) .413 58.92 (7.16) 53.41 (6.77) .067 Sleep disturbance 51.17 (9.20) 50.62 (9.48) 52.69 (8.30) .219 53.84 (9.02) 52.08 (8.36) .828 Pain interference 50.64 (8.78) 50.46 (8.87) 51.12 (8.61) .681 55.65 (9.33) 48.43 (7.47) .027 Anxiety 58.00 (8.89) 56.70 (9.42) 61.61 (5.93) .002 63.55 (5.99) 60.57 (5.96) .336 Depression 51.86 (9.08) 50.94 (9.45) 54.43 (7.50) .034 56.62 (7.55) 53.32 (7.48) .443 Notes: * 13 participants missing state identifiers. a Prefer not to answer n = 2. b Totals >156 due to “check all that apply”. Other: American Indian/Alaskan Native n = 1; Middle Eastern/North African n = 3; Unspecified n = 1. c Other: Student n = 12; Homemaker n = 9; Out of work >1 year n = 4; Out of work <1 year n = 2; Unable to work/disabled n = 2; Unspecified n = 1. d Prefer not to answer n = 10. e Other: Colorectal n = 6; Cervical n = 5; Sarcoma n = 5; Other n = 13 (n = 1 for Mouth, Lung, Melanoma, Multiple Myeloma, Testicular, Thyroid, etc.). f Cancer stage – 1: n = 21 (13.7), 2: n = 80 (52.3%), 3: n = 34 (22.2%), 4: n = 19 (11.8%). Cannabis Use Among Young Adult Cancer Survivors 32 First and Current Use for Medical vs. Non- Medical Purposes Of those reporting lifetime use, 70.6% (n = 48/68) reported first using for non-medical purposes and 26.5% (n = 18/68) for medical; reasons for first medical use included anxiety (n = 7), pain (n = 5), chemotherapy in general (n = 4), insomnia (n = 3), nausea (n = 2), and cancer in general (n = 2). Shown in Table 3, among those reporting past- month use, 9.8% (n = 4/41) reported using for only medical purposes, 29.3% (n = 12/41) primarily medical but some non-medical (‘recreational’), 14.6% (n = 6/41) equally medical and non-medical, 14.6% (n = 6/41) primarily non-medical but some medical, and 9.8% (n = 4/41) only non-medical. Common reasons for current medical use among the 8 people who responded to that question included pain (n = 3), insomnia (n = 3), survivorship in general (n = 3), anxiety (n = 2), fatigue (n = 1), and nausea (n = 1). Among those reporting lifetime use, the majority reported first use for non-medical purposes but no past-month use (25.0%, n = 17/68), current use for only non-medical purposes (13.2%, n = 9/68), primarily medical but some non- medical (10.3%, n = 7/68), equally medical and non-medical (7.4%, n = 5/68), primarily non- medical but some medical (5.9%, n = 4/68), or only medical (4.4%, n = 3/68). Others reported first using for medical purposes and current use primarily for medical but some non-medical purposes (11.8%, n = 8/68), only medical (4.4%, n = 3/68), equally medical and non-medical (4.4%, n = 3/68), no past-month use (2.9%, n = 2/68), or currently using for primarily non-medical but some medical (1.5%, n = 1/68; Note: n = 5 did not respond to 1 of the 2 assessments.) Table 3. Cannabis-Related Factors by Reason for First Use Among Participants Reporting Past-Month Use Reason for first use Past-month use n = 41 (100.0%) Medical n = 13 (31.7%) Non-medical n = 26 a (63.4%) Variables M (SD) or n (%) M (SD) or n (%) M (SD) or n (%) p Days used, past 30 days (M, SD) 10.00 (10.54) 14.92 (11.57) 8.00 (9.66) .108 Has medical cannabis card (n, %) 11 (26.8) 6 (46.2) 4 (15.4) .093 Current use purposes (n, %) b .020 Only medical 4 (9.8) 1 (7.7) 2 (7.7) Primarily medical, some non-medical 12 (29.3) 8 (61.5) 4 (15.4) Equally medical and non-medical 6 (14.6) 3 (23.1) 3 (11.5) Primarily non-medical, some medical 6 (14.6) 1 (7.7) 4 (15.4) Only non-medical 4 (9.8) 0 (0) 4 (15.4) Current primary use mode (n, %) c Smoked 6 (14.6) 2 (15.4) 3 (11.5) .332 Vaporized 9 (22.0) 3 (23.1) 6 (23.1) .744 Edibles 31 (75.6) 11 (84.6) 19 (73.1) .503 Current primary source (n, %) d .531 Medical dispensary 9 (22.0) 4 (40.0) 4 (16.0) Non-medical dispensary 19 (46.3) 5 (50.0) 14 (56.0) Don’t buy; get it from friends 5 (12.2) 0 (0) 4 (16.0) Dealer 2 (4.8) 0 (0) 2 (8.0) Note. a Prefer not to answer n = 2. b Prefer not to answer n = 9. c Other n = 1. d Prefer not to answer n = 4; other n = 1. Bivariate Analyses Assessing Correlates of Medical vs. Non-medical Use Table 1 shows bivariate analyses assessing factors associated with first use for medical vs. non-medical purposes among those reporting lifetime use. Those reporting lifetime use who first used medically (vs. non-medically) reported lower physical function (M = 44.33, SD = 6.47 vs. M = 49.38, SD = 7.77, p = .036) and greater pain interference (M = 55.96, SD = 8.23 vs. M = 49.47, SD = 8.59, p = .018), as well as marginally lower likelihood of employment (55.6%, n = 10 vs. 89.6%, n = 43, p = .068), higher likelihood of having ≥$4,200 monthly household income (55.6%, n = 10 vs. 79.2%, n = 38, p = .074), and lower ability to participate in social roles/activities (M = 47.07, SD = 8.25 vs. M = 52.04, SD = 8.17, p = .066). Table 2 also shows bivariate analyses assessing factors associated with first use for Cannabis, A Publication of the Research Society on Marijuana 33 medical vs. non-medical purposes among those reporting past-month use. Those who first used for medical purposes (vs. non-medical) reported greater pain interference (M = 55.65, SD = 9.33 vs. M = 48.43, SD = 7.47, p = .027), as well as marginally lower income (53.8%, n = 7 vs. 73.1%, n = 19, p = .088) and ability to participate in social roles/activities (M = 46.39, SD = 8.94 vs. M = 52.59, SD = 7.96, p = .065) and greater fatigue (M = 58.92, SD = 7.16 vs. M = 53.41, SD = 6.77, p = .067). Factors Associated with Cannabis Use Bivariate analyses (Table 1) indicated that those reporting lifetime use (vs. not) reported greater anxiety symptoms (M = 60.21, SD = 7.83 vs. M = 56.27, SD = 9.32, p = .006), as well as marginally greater depressive symptoms (M = 53.44, SD = 7.69 vs. M = 50.63, SD = 9.91, p = .056). Shown in Table 2, factors associated with past-month use included more likely receiving chemotherapy treatment (n = 40, 97.6% vs. n = 98, 86.0%, p = .042) and reporting more anxiety (M = 61.61, SD = 5.93 vs. M = 56.70, SD = 9.42, p = .002) and depressive symptoms (M = 54.43, SD = 7.50 vs. M = 50.94, SD = 9.45, p = .034). In the multivariable binary logistic regression model assessing factors associated with past- month use among all participants (Table 4), past- month use was associated with less advanced cancer stage (compared to stage 1, stage 2: aOR = 0.12, 95%CI = 0.03, 0.44; stage 3: aOR = 0.16, 95%CI = 0.04, 0.67; stage 4: aOR = 0.17, 95%CI = 0.03, 0.92), treatment involving chemotherapy (aOR = 15.37, 95%CI = 1.49, 58.09), and greater anxiety symptoms (aOR = 1.11, 95%CI = 1.02, 1.21). In the regression model assessing factors associated with past-month use among those reporting lifetime use (Table 4), past-month use was associated with being male (vs. female; aOR = 12.50, 95%CI = 2.08, 28.43), cancer stage 1 vs. 2 (aOR = 0.11, 95%CI = 0.02, 0.85), greater anxiety symptoms (aOR = 1.18, 95%CI = 1.03, 1.34), and using first for non-medical purposes (aOR = 4.76, 95%CI = 1.15, 20.00). Table 4. Multivariable Binary Logistic Regression Identifying Factors Associated with Past-Month Cannabis Use Among All Participants and Among Participants Reporting Lifetime Cannabis Use (Assessing Reasons for First Use as a Correlate) Past-month cannabis use among all participants Past-month cannabis use among participants reporting lifetime use Variables aOR 95% CI p-value aOR 95% CI p-value Sociodemographic factors Age 1.04 0.95, 1.13 .445 1.04 0.94, 1.16 .441 Male (ref: female) 1.41 0.34, 5.88 .631 12.50 2.08, 28.43 .006 Medical history Cancer stage (ref: 1) 2 0.12 0.03, 0.44 .001 0.11 0.02, 0.85 .034 3 0.16 0.04, 0.67 .012 0.20 0.03, 1.62 .132 4 0.17 0.03, 0.92 .039 0.30 0.02, 4.15 .366 Chemotherapy (ref: no) 15.37 1.49, 58.09 .022 1.24 0.19, 7.93 .823 Years since treatment completed 0.90 0.59, 1.36 .603 0.76 0.42, 1.38 .363 Quality of life – PROMIS Social roles/activities 1.02 0.94, 1.11 .693 0.97 0.86, 1.11 .683 Physical function 0.99 0.91, 1.08 .891 1.01 0.89, 1.14 .895 Fatigue 0.96 0.89, 1.05 .389 0.96 0.85, 1.09 .531 Sleep disturbance 1.02 0.96, 1.07 .580 1.06 0.98, 1.14 .158 Pain interference 0.73 0.24, 2.24 .583 0.41 0.09, 1.94 .261 Anxiety 1.11 1.02, 1.21 .017 1.18 1.03, 1.34 .017 Depression 1.02 0.95, 1.09 .651 0.94 0.84, 1.05 .244 Used first for non-medical purposes (ref: medical) -- - - -- 4.76 1.15, 20.00 .031 Nagelkerke R-square .263 .389 Note. Including state laws for medical or non-medical cannabis use did not significantly contribute to the models and reduced power; thus, models not including those legal factors were presented. Cannabis Use Among Young Adult Cancer Survivors 34 DISCUSSION In this sample of young adult cancer survivors, over 40% had ever used cannabis, with over 70% reporting first using for non-medical purposes and over one-fourth first using for medical reasons. Two prior studies documented similar findings, with 50-80% of those who currently used cannabis indicating that they had used prior to cancer treatment (Donovan et al., 2023; Podda et al., 2020). Furthermore, over one-fourth reported past-month use, with only ~10% using only for medical purposes or non-medical purposes, respectively. The remainder used for a mix of medical and non-medical purposes (i.e., ~30% primarily medical, ~15% primarily non-medical, ~15% equally medical and non-medical). Another key finding in the current study was that, among participants reporting lifetime use, past-month use was associated with first using for non- medical purposes. This is particularly important given that one study found that nearly half of those who first used cannabis before diagnosis increased their use during treatment (Podda et al., 2020). Notably, the vast majority of existing research on cannabis use among young adults with a history of cancer has focused on medical cannabis use and use during treatment; much less research (Donovan et al., 2023; Podda et al., 2020) has assessed cannabis use outside of the cancer treatment period or for reasons other than medical purposes among young adults with a prior cancer diagnosis. This is particularly relevant for young adult cancer survivors who may have higher rates of cannabis use than older groups and feel more hesitant to discuss their cannabis use with oncology treatment teams (Baral et al., 2024). Commonly-endorsed reasons for medical use in this sample included pain, insomnia, anxiety, and nausea, and some participants reported more general cancer-, chemotherapy-, or survivorship- related reasons. Aligning with these medical use motives, past-month use was associated with greater anxiety symptoms and receiving treatment involving chemotherapy. These findings are consistent with findings from several studies regarding common medical use motives (Donovan et al., 2021; Donovan et al., 2023; Halpern et al., 2024); some prior research suggests that young adult cancer survivors indicate that cannabis is effective for addressing these symptoms (Donovan et al., 2023; Halpern et al., 2024). Unfortunately, like most prior studies, this study did not distinguish and assess young adult cancer survivors’ reasons for non-medical use. A previous study found differences in use motives outside of cancer treatment (e.g., social and enhancement motives) vs. during treatment (e.g., pain, sleep; Podda et al., 2020) which may be mirrored in the current sample, many of whom used for dual purposes. Current results also highlight important use characteristics among this population. For example, studies in the US have shown that smoking cannabis is a common mode of consumption among young adults in the general population (Berg et al., 2024; SAMHSA, 2024) and young adult cancer survivors (Donovan et al., 2023; Vinette et al., 2022). However, this study and others have shown that ingesting via edibles or oils are distinctly relevant modes among young adult cancer survivors (Donovan et al., 2023; Vinette et al., 2022). This may reflect young adult cancer survivors awareness of the carcinogenic effects of combusted cannabis use along with attempts to minimize cannabis-related risks (National Academies of Sciences & Medicine, 2024). Current findings have implications for research and practice. First, the sparse research to-date that has explored both medical and non- medical cannabis use has indicated the importance of assessing both use motives across the spectrum (pre- to post-treatment; Donovan et al., 2023; Podda et al., 2020). Future research must leverage various designs (e.g., qualitative, longitudinal) in order to better understand different motives for use and how use patterns may evolve over time. In particular, longitudinal research using comprehensive and precise assessments is needed to characterize patterns and trajectories of cannabis use – as well as other substance use and health outcomes more generally – before, during, and after treatment in order to elucidate the associations among cannabis use, mental and physical health, and changes in specific symptoms (e.g., pain, sleep). Finally, future research should also focus on identifying individuals who may experience medical benefits from medical use, as well as potential detrimental effects of use. Limitations Cannabis, A Publication of the Research Society on Marijuana 35 While the sample was drawn from across the US, it was limited in diversity and size, hindering power for some analyses and the ability to assess subgroup differences. Further, self-selection bias may have impacted findings. Assessments were also limited and did not capture all potentially relevant factors influencing use or use characteristics, or motives (e.g., non-medical motives). Thus, more comprehensive research using various designs (e.g., qualitative, longitudinal) is warranted with a larger, more diverse sample, particularly involving greater representation of under-researched populations (e.g., men, sexual minorities, racial/ethnic minorities) Conclusions A large proportion of young adult survivors first used cannabis for non-medical purposes but also reported medical use. It is crucial to understand use motives and trajectories over time to identify those who may benefit from medical use or face use-related harms. Qualitative studies are needed to provide in-depth insights on use motives, characteristics, and related mechanisms, and longitudinal studies are needed to elucidate changes in cannabis use motives, trajectories, and related effects over time. REFERENCES Abrams, D. I. (2022). 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We would like to thank the participants of this study. Author’s Contributions: Darcey M. McCready: Conceptualization, Data collection, Data curation, Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing. Laura Schubel: Conceptualization, Methodology, Writing – review & editing. Hannah Arem: Conceptualization, Data collection, Funding acquisition, Investigation, Methodology, Project administration, Supervision, Writing – review & editing. Cassidy R. LoParco: Conceptualization, Methodology, Writing – review & editing. Afrah Howlader: Conceptualization, Methodology, Writing – review & editing. Sheena Shajan: Conceptualization, Methodology, Writing – review & editing. Palash Bhanot: Conceptualization, Methodology, Writing – review & editing. Carla Berg: Conceptualization, Data collection, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Writing – original draft, Writing – review & editing. Ethical Approval: This study was approved by the George Washington University Institutional Review Board (IRB# NCR224269). Informed consent was obtained from all study participants. Data Availability Statement: Limited data from this study are available on request from the corresponding author. Copyright: © 2025 Authors et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction, provided the original author and source are credited, the original sources is not modified, and the source is not used for commercial purposes. Issue Date: November 03, 2025 Citation: McCready, D. M., Schubel, L. C., Arem, H., LoParco, C. R., Howlader, A., Shajan, S., Bhanot, P., & Berg, C., J. (2025). cannabis use for medical or non-medical purposes in a sample of young adult cancer survivors in the United States. Cannabis, 8(3), 26–37. https://doi.org/10.26828/cannabis/2025/000321 https://creativecommons.org/licenses/by/4.0/